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Sunday, May 1, 2011

Pregnancy During Residency: A Retrospective

A lot of people seem to ask questions about whether it's "possible" to have a baby during residency. Obviously it's possible! What you're really asking is: how much does it suck?

When I was pregnant with my daughter, I had a laundry list of complaints about being pregnant during residency. These are a few that still stick with me:

1) My chief resident initially told me that I could only take 3 weeks maternity leave.

2) It was generally the resident's job to hold patients' heads during flexion-extension spine films, which would come up maybe every other week or once a month. Most of my attendings understood that I couldn't be in the way of X-ray beams and would generally do it themselves. I had one attending (a mother herself) who seemed baffled by why I didn't want to do it. "But you'll be wearing lead," she pointed out. She refused to do it for me and made me find another resident willing to do it. (And the first resident I asked was a total jerk about the whole thing, immediately asking what I'd do for him in return.)

3) I had to start a new rotation during my last month of pregnancy (our rotations lasted several months). That meant the call cycle reset, so they tried to squeeze several months of call into that month for me. And the rotation itself, while not one with long hours, was physically strenuous, involving walking all over a hospital that was several different buildings spread out over maybe half a mile. I begged for any clinic rotation that would involve less walking and more sitting. No dice.

4) I had this conversation with my program director. Except we actually had the conversation via email, so the whole ridiculous exchange is saved in my inbox for posterity.

5) The tremendous guilt trip laid on me. Notably, an email was sent out by the chief saying that nobody was allowed to take vacation while I was on maternity leave. (This did not happen.) I envisioned that everyone hated me and made myself miserable over it. I don't think everyone actually hated me, although I think a few people did, and they were probably not the same people I thought hated me.

Now I have the perspective of time and I realize that my program, at the time, was just ill prepared to deal with a pregnant resident. The residents were mostly men (I was temporarily transported back to the 60s for residency) and there hadn't been any maternity leaves in 2-3 years. Nobody was entirely sure what to do. I do know there were people who stood up for me and tried to make my life easier. And in retrospect, I should be grateful to those people rather than pissed off at everyone else.

Also, I feel like I could have been a little (lot) less whiny. I think I went overboard with the "poor me" routine. Yes, I was a pregnant resident, which sucked. But it could have been worse. I could have been a pregnant surgery resident.

I think back then I lacked a certain maturity (another argument against 6 year MD/BS programs... 24 is WAY too young to be a doctor). In retrospect, I'm a little embarrassed by the way I reacted to certain "unfair" situations early in my residency. I still think the X-ray beam thing was really really wrong, but beyond that, I feel like I should have just sucked it up, realized that it was my choice to have a baby during residency, and been better at accepting my situation. It wasn't great, but it wasn't all that bad either.

51 comments:

My thoughts on my recent residency pregnancy...I have the benefit of direct comparison as I started my pregnancy being a regular surgery resident and ended it in the lab. Its doable as a resident but not that easy and not necessarily that healthy. My pre-lab portion of my pregnancy involved two trips to the ER (one for severe cramping that wouldn't stop after standing for 6 hours in a hot OR another for bleeding), a near faint in the OR after coming back from a prenatal visit with lots of blood drawn, and I also had slightly elevated blood pressure.

Once I started in the lab, my blood pressure normalized, I stopped bleeding and had a delightfully healthy pregnancy. I really thought I was coping well before I went in the lab and I felt like of the people who knew I was pregnant, more often than not, were supportive and tried to help when I needed it. However, I had also worked with these same people as they complained about other pregnant residents. When I started in the lab and worked near normal hours it was amazing what a difference it made. So, you can do it in residency, but obviously its easier if you can find a way to lighten the load without compromising your fellow residents. Residency programs are just not designed to deal with resident absences or restrictions. Until we solve this problem, pregnancy in residency will be hard.

Yeah, it seems like practically every pregnant resident I know had an episode of bleeding and cramping. Despite my retrospective analysis, there truly is no comparison between being pregnant as a resident and being pregnant in a job with normal hours, no call, where you can sit or go to the bathroom whenever you want.

Stories like these make me glad that I'm 99% (the 1% comes from neither of us being permanently fixed) sure my baby-making days are behind me. I fully admit that I am just a terrible pregnant person (I get ridiculously sick and even a zofran/phenergan combo doesn't fix it) and really don't think I could survive residency in that state.

I always commended women that had kids in any residency program. In my husband's program, several women had kids during residency and people were just sort of dicks to them. Granted, they sort of bullied the peds director into 3 months of maternity leave and still being able to finish on time, but still -- I thought it was a little over the top.

But, I have to say I'm a little puzzled by the x-ray thing -- I had to have a few x-rays during pregnancy and my OB said that they were pretty safe, which I would think is particularly true if you were wearing the lead coat.

Fizzy - true. I've always thought that maybe that Benjamin Button movie had it right. When we are young and stupid, why not have a feeble body so we don't do anything stupid? And the best time to have a youthful body is when you have gathered the wisdom of the years and the experience to appreciate it, and then we can have the babies then.

hmmm... I've been sternly told, repeatedly, to X-ray the pregnant woman if I suspect something. And there's no way in hell I'd be allowed in that lead coat and near an X-ray, if I were pregnant.

Anonymous at peds... Really? Finished on time? I mean, we have it cushy in that I can take the same maternity leave as anyone else, if I want to, so up to a year, and the chief happily recombines the call schedules which vary wildly every month anyway. But 1 month or 1 year, our rotations are stopped, and we have to make up all the time we miss.

I absolutely knew somebody was going to comment and chime in that the X-ray wasn't a big deal.

I know there are women who work in radiology and wear lead during their pregnancies, and that a single X-ray isn't *that* much radiation, blah blah blah. But it certainly IS a risk, and to be asked to have X-ray exposure up to two times a month during pregnancy is a fairly big risk. It's one thing to abuse ME, but it's another thing to risk harming a fetus because you can't be bothered to waste 10 minutes of your time. If there were some emergency situation where I needed the X-ray for my health, then we could weigh the pros and cons. But why take that risk when there are tons of non-pregnant people around who could do it?

Incidentally, there was one situation when I was supposed to go hold a patient's head for an X-ray when I *wasn't* pregnant, and the very nice attending stopped me and told me she'd do it because while I wasn't pregnant, I was still in my "childbearing years."

Snarky: I agree... I never heard of anyone getting to take off 3 months and not make it up. My university had rules that any time over 6 weeks taken off for any reason during the year had to be made up.

I would imagine that being near an xray with lead on (even 2x per month) probably isn't a big deal.... but it was still obnoxious for your attending to make a stink about holding the patient's head. Is it REALLY that important to you not to do the resident's job for like 10 seconds? She sounds like a primadonna.

OMDG: There's a lot of radiation in Pain Medicine, so I know that X-ray techs used counters while pregnant and the lead does seem to protect them. But for them, that's their entire job. For me, it was a totally unnecessary risk, which absolutely nobody else asked or expected me to take. Other attendings would just go down and do it themselves without even mentioning it to me.

That attending wasn't a bad person, but she was horrible to work with while pregnant (or otherwise). She would spend the entire day, literally 8 to 6, rounding and sometimes not even manage to see all the patients or accomplish anything really. And when I had to leave a little early to get my diabetes screen, I let her know a month in advance and every day leading up to the test.... then suddenly, on that day, she decided she needed to leave early too for an appointment. Come on!

Re: x-ray - I wouldn't have volunteered to stand in for you, either, because my sister had thyroid cancer. As a result of her diagnosis, my siblings and I are very careful about our radiation exposure.

@Snarky -- I swear to god, both of the women got three months off and were completely done with residency on time. They had their kids during their second year and the agreement with the director was that they would "try" to publish something and they couldn't get any vacation their 3rd year. (This program allows 4 weeks of paid vacation per year.) The director is literally the nicest man on earth, but residents really took advantage of this.

There really is no ideal time for baby in Medicine. I did not have the opportunity during residency: no partner but I am still glad I waited until after fellowship, mainly for my maturity. The Xray thing sucks Fizzy....

I started fellowship 2 months late, and was hated by my new peers from day one, b/c they had to cover my half clinic day per week and calls from home.At the end of first fellowship year I was pregnant with #2, and the last month was given double amount of calls, even though I was on call 12 months like the rest of them, only with dated shifted 2 months forward. My fellows did not even take into consideration that while I was doing double calls from home, I was saving them/us all to cover for a new woman-fellow who was starting her first year 2 months later due to baby too. So, she was not so hated, b/c I was there in my last weeks of pregnancy to take her calls(an then some). When I took my 3 week maternity leave, them made me pay all my calls back. Yeah, and people who hated me were single or childless women. What's with integrity these days?

i had my second child in third yr of fellowship.I had a completely different experience than you did. My co fellows were very supportive (all male crew) as were my attendings. for me, the ground work was laid long before. i got 8 weeks off after my csection, i frontloaded all my calls and essential rotations so that none of my other fellows did an extra hr of work ....if anything, i ended up doing more than they. i was routinely standing with at least 15 pounds of lead over me for 3-6 hrs at a time, rounding, doing clinics, taking 24 hr call with no post call relief, and covering for other absent fellows....i did it all so that when i left to give birth, no one had a leg to stand on with complaints . it worked. we work with a lot of radiation as cardiologist . i was leaded for all my procedures and got very educated about radiation exposure and risks to the unborn. at the doses that the operator is exposed to, with correct shielding it is small. the studies done on fetal exposure were done on atomic bomb survivors who were exposed to much higher doses than that used in medicine. if despite the evidence of a small risk of exposure i had refused to do my procedures, there would have been a lot of resentment. Plus my education would have been compromised.i did not have health issues in contrast to my first when i had bleeding, pre eclampsia and abruptio. At that time, i was 25, married to a fellow doctor, graduated from a 6 yr med school at 23, worked in primary care as a GP for 2 yrs and VERY mature....my life then was compltelty stressless but the pregnancy sucked.sure pregnancy is possible, safe and do-able during residency/fellowship. The most important thing is to have no fear, be a hardworker all the time, pray for a healthy pregnancy and go for it. every pregnancy is different but being prepared is the key.

I was pregnant as a 3rd year med student, and I still had just as much trouble with the xray thing. Mostly because I had to go with my surgeon to spine surgery and they had so much darn fluoro running. I tried to stay out of the way, but since that was the surgery of the day, I had to do it. It sucked. That whole experience really cast a bad light on surgery for me.

And I agree with the cramping/bleeding thing too. I had tons of preterm labor and I know it was from standing up all day and not peeing. And the late nights from front loading all my call for the year (which I did appreciate after having my little one).

But hey, at least I got 3 weeks off! Our dean said she came back on Monday when she had her kid Friday....yeah, that wasn't going to happen for me.

All and all while 3rd year sucked a lot, my little one is totally worth it.

Oh, and if you are pregnant in medicine, everyone will assume it was an "oops baby", or at least they did with me. Mine wasn't. It was IVF. And those jokes about "didn't think med students had enough time at home to get pregnant" were even funnier since I got pregnant in a lab...

CardioMom - I was covering for all sorts of abcent residents when I was very pregnant (noone paid me back or I expected them to). And I always worked hard (er than most) in my fellowship. That still did not save me from their resentful feelings when I was inconviniently abcent for 3 weeks. I was taken aback when during my last month of pregnancy, calls were added to my schedule. It depends where you train. I noticed that the higher up your institution is, the more ruthless they are on you.

Anon@8:49AM: I knew a med student who tried to get out of radiation due to family cancer history. No dice on that one. I can sort of understand it too because a lot of people have family cancer histories and it really would exempt way too many people.

CardioMom: Re the radiation, it might have been a different story if there were any learning value associated with the exposure. It was basically just a liability thing for us. I held other residents' patients' heads during procedures where there was no radiation involved as a favor to them, but they conveniently forgot about that. I'm not thrilled about radiation exposure in general, so I avoided it as a career, but I was always willing to do it during training except for those 9 months.

During my last year of residency, there were several residents who were out due to babies. There was one resident that I was supposed to be on a service with who had to take a family leave and instead I ended up doing the work of 2 people. But I wasn't upset about it at all-- just the opposite. I actually felt grateful for the chance to pay it forward.

>>I knew a med student who tried to get out of radiation due to family cancer history. No dice on that one. I can sort of understand it too because a lot of people have family cancer histories and it really would exempt way too many people.>>

Actually, that is not what I said: I wouldn't have refused my fair share radiation exposure because, after all, that would have been part of being a resident. What I meant is: I would have refused to cover for anyone, including you and any other pregnant women, because that would have meant increasing the risk to me. Why should I put myself at risk just to decrease risk to your baby? Not happening.

Anon: For the record, the residents who refused to help didn't do it because of radiation risk, but because they didn't want to take 10 minutes out of their day to help. When it came to the fluoro lab and doing injections, the residents were only too happy to jump in for me and take on the much higher levels of radiation, because fluoro injection experience was very coveted.

But if there were a pregnant resident who needed me (while not pregnant) to get that bit of radiation exposure in order to spare her baby, I *absolutely* would have done it. Fetuses exposed to radiation can either die or have gross congenital malformations, which I think is much more horrible than increasing my cancer risk a teeny tiny bit. So I'd take the radiation to spare the baby.

Properly shielded pregnant women are at very low risk for giving birth to fetuses with congenital malformations. As you said yourself, radiology techs are exposed to radiation while pregnant and don't seem to have problems - even though, "that's their entire job".

After seeing what my sister went through, avoiding thyroid cancer is more important to me than the health of anyone else's fetus.

I think, while low, the risk to the fetus, especially in the first or second trimesters, is still higher than the risk to a non-pregnant person. Plus the risk is more immediate. Most people have some family history of cancer (I do, in my immediate family). I'd feel selfish if I made a pregnant woman expose herself to that when I could have helped out.

Well, I'd feel selfish if I asked someone else to assume risk I accepted by choosing to enter residency training that required radiation exposure just because I am at increased risk for developing thyroid cancer.

I wouldn't feel selfish at all for declining to accept additional risk just because someone was pregnant, (or had increased risk of cancer, for that matter). I also might not tell you why I wouldn't do it, or I might white lie (say I'm TTC, for example, which seems to be one of the few excuses you'd accept).

Others offering to accept additional risk and EXPECTING others to accept risk on behalf of your fetus are two different things. Furthermore, my mother would be very upset if she found out someone like you expected me to accept additional risk just because you were pregnant. She's terrified of losing my sister, and her other children. Actually, she'd also think you were selfish for not taking time off from training - thus avoiding all radiation exposure - because she blames herself for my sister's cancer, because she had dental x-rays taken while she was pregnant. Not rational, but fear isn't rational. If your fears were rational, radiology techs would commonly give birth to deformed babies.

You keep telling me my fear isn't rational, yet then you say that you're afraid of taking that risk yourself. I do think the risk is small. But if there is a risk, it's commonly thought that this risk is higher for a fetus than for an adult. (Obviously no controlled studies could ever be done.)

It wasn't like I was in a radiology residency. I specifically asked to put off my fluoro rotation till after my pregnancy. Holding patients' heads during X-rays was not something I had any idea I'd ever have to do, and was something that didn't come up that often. And 99% of the attendings and staff members wouldn't let me near the radiology department while I was pregnant... when I even mentioned it, they seemed horrified. And when I went to do this task as a non-pregnant resident, the radiology tech asked me like five times if I could be pregnant first, so it's not like this is some weird thing that only I'm worried about. Nobody asked me if I had family members with cancer and there's no checkbox for that on every x-ray form (like there is for pregnancy). So obviously there's a difference.

(That said, if you were in my residency program and tried to use radiation fear as an excuse, I'd have to call bullshit because PM&R residency has a good amount of radiation exposure. One afternoon in the fluoro lab is probably way more radiation than covering flex-ex films for every resident on the service for a whole year. Honestly, even though we're arguing over this, I do understand you being worried and I probably wouldn't have asked a resident who had a sister with thyroid cancer and seemed genuinely nervous about this. My gripe was just that nobody wanted to do it because they couldn't spare the 10 minutes of time, not because they were worried about radiation.)

As I said already, I probably wouldn't tell you my family history, because 1. it's really none of your business and 2. assuming I'm in the program, I've accepted the risk inherent in performing required tasks (but NOT additional risk, like covering for you). I do know the risk to me is small, but I also know, the more radiation, the more risk. My thyroid will be exposed over the course of a lifetime, after all.

I still wouldn't cover for you. As to why very few others would, I think you answered this yourself in your original post: you were whiny, cried "poor me", immature and reacted badly to "unfair" situations (probably because you could not see the other person had a valid point-of-view). You were exactly the sort of person I avoid at work.

Yes, there is a difference between pregnancy and family history of cancer. That difference is lawsuit potential. Checkboxes on consent forms are all about preventing lawsuits, not necessarily protecting patients.

Defective infant? Must have been those rads of the mother's fractured tibia during the first trimester!!! Sue everyone!!!

Cancer 10 (or 20 or 30) years from now? Unlikely to be connected with earlier radiation exposure, though undoubtedly, it sometimes is. In any case, much less lawsuit potential.

As I said before, 99% of the people in the program covered for me without even questioning it. It was just that one instance when I had a problem. Most people are incredibly understanding about pregnant women not wanting to expose themselves to radiation. On one occasion, we were taking a film in a patient's room, and my attending just leaded up and said to me, "Get out. You can't do this." Actually, that happened more than once.

There was one med student I remember who had some reason she was more worried about cancer for some reason (not pregnancy) and refused to expose herself to radiation. She was skewered by the residents for this. And prior to that, she was known for being kind of "high maintenance" and always finding convenient excuses to get out of work. I guess that's why I reacted to your comments that way... because your attitude reminded me of that med student. Nobody wants to expose themselves to a higher cancer risk, obviously, but there's a reasonable amount of radiation exposure during medical training, and you seem unreasonably hyper about it. As I said, I have a family history too, but I covered for residents in the fluoro suite many times when I wasn't pregnant. I don't know what you're training in, but that attitude is going to bring up red flags.

We can argue about this forever. But the point is: you're sensitive about radiation because of your sister. And I'm sensitive about someone saying, "Screw your unborn baby, I'm looking out for myself." It's understandable we're both getting riled up. I do think we both have some valid arguments.

>>I don't know what you're training in, but that attitude is going to bring up red flags.>>

I'm finished with training, and have been practicing for several years, but thanks for your concern. In case you're interested, I never made a big deal out of my situation. My private business stays private, and most people, other than a couple of close friends, didn't know.

As for being "high maintenance": I do not understand how being unwilling to cover for someone could be considered "high maintenance" (asking to be exempted: yes, but I never did this). On the contrary, I'd consider your expectation that everyone be willing to assume extra risk on your behalf to be high maintenance, especially when you casually dismiss the much greater risk to pregnant radiology techs ("that's their entire job"). For this reason, I'm not at all shocked you had a somewhat miserable training experience about which you still feel bitter.

>>But the point is: you're sensitive about radiation because of your sister. And I'm sensitive about someone saying, "Screw your unborn baby, I'm looking out for myself.">>

Think about it this way: I wouldn't expect you to be more concerned about me than you are about your baby. Why should you care about me? Why should I care about your baby? It cuts both ways.

>>It's understandable we're both getting riled up.>>

You may be riled up. I thought we were having a rational discussion. Apparently not.

>>I do think we both have some valid arguments.>>

Good. Just remember: those who refused to cover for you may have had valid arguments, too. Sometimes it is reasonable to say "no" without any explanation, though you apparently find this hard to accept.

Of course, if you were the type of person who flounced off and whined and gossiped and trash-talked the person who said "no" to you, I can also understand why certain people weren't motivated to help you... and maybe why some people might have, out of fear.

"You may be riled up. I thought we were having a rational discussion."

Really??

When people are having a rational discussion, they don't get personal. You were getting personal. You said to me, "you were whiny, cried "poor me", immature and reacted badly to "unfair" situations (probably because you could not see the other person had a valid point-of-view). You were exactly the sort of person I avoid at work."

Do you think that's a nice thing to say? If we were having a discussion at a conference or even a dinner table, is this really something you would say to another person? You don't know me and you got personal and pretty nasty. You have no idea what I was really like in residency or what I am like at all.

From your comments, you sounded like someone who was still early in training, maybe even a premed, who had no kids.... so that shows you how much you can tell from words written on the internet about someone you don't know. But I thank you for taking my mind temporarily about something else I was worried about.

Incidentally, the way I found out about the "holding patient's head" rule is that I volunteered to help another resident who seemed busier than me. He told me this needed to be done and I was on my way down to radiology until a nurse stopped me and told me not to go because I'd actually have to be in the way of the X-ray beam. The resident who asked me hadn't realized this either. Instead I took out some sutures for him. Residency involves helping other people and covering for them when they need it, whether or not they're pregnant. That's why I was surprised you had gotten through training and didn't seem to realize that.

>>You have no idea what I was really like in residency or what I am like at all.>>

I simply repeated words you'd used to describe yourself. Did I misquote you?

I'm quite aware that residency involves helping other people, but not at the cost of putting myself at increased risk. As I said, several times: I never asked for special consideration. You expected and asked for special consideration. Not only that, you continue to dismiss risks taken by pregnant radiology techs because "that's their job". Obviously, the risk to a properly shielded pregnant woman is low, just as the risk to a properly shielded person at increased cancer risk is also low. Neither pregnant women nor people with my family history should subject themselves to more radiation than is absolutely necessary. Obviously, we shouldn't have been covering for one another, because the question of whose life is more important cannot be answered impartially.

I chose not to disclose my personal situation, and didn't expect to be exempted from any duties (obviously - my situation is invisible). You, being pregnant, had an obvious situation after a certain point. You expected others would cover for you. Some did. A few didn't. I'm saying the few that didn't might have had good reason. You don't know for sure, and you don't have any right to know others' private business.

I think it's sort of funny when people say something obviously bitchy, then I call them on it, and they're all innocent and like, "What? What are you talking about?" Yes, you quoted me but also twisted what I said. I'm willing to admit I said some bitchy things to you. Why won't you admit it too? If you really don't recognize that what you said to me was nasty, then you would be the sort of person I'd avoid at work too. (And my saying that is totally part of our "discussion" and not a personal attack at all :)

I am sympathetic to radiology techs who are pregnant but I just don't see a way out of that situation. If you have one or two X-ray exposures a month, that can be worked around. If that's your entire job, then how can you do anything but find a new job?

By the way, you never addressed whether or not you have children and were ever in a position where someone asked you to put your fetus at risk. Putting my baby at risk was so much more awful than putting myself at risk. I could care less about myself.

I have been a long time reader of MIM and have truly enjoyed reading all the posts as a silent observer.

However after reading this most recent discussion something has been bothering me all day...I cant seem to get it out of my mimd and hence have finally decided to post!

Anon- no offense but your attitude is whats wrong with the world.

You opinion that you wouldnt cover because of whateverwhatever is yours, and you are entitled to it as Fizzy is entitled to hers.

However, if you value your privacy that much and dont like disclosing stuff then maybe you should just stay off public blog sites. I refuse to beleive that a person not plagued by serious personal issues could be that bitchy.

Pregnant residents generally stayed out of the rooms of those kids who had confirmed or suspected influenza or CMV. Other team members/residents/fellows/attendings would typically step up to care for these kids without any complaint or problems whatsoever. Is that because so many peds programs are woman heavy? Or was it was my good luck that I worked with people who were fine with it? I'm not sure.

Wow Anon! Fizzy's original post actually said that she had regrets about some of her reactions during her pregnancy. this was actually one of the most even-toned blogs about residency I have seen her write.

We all work hard to avoid risk to our baby. I am a coffee-addict but gave my cup of joe.(and wondered about that when I gave chemo to my pregnant lymphoma patients) I think Fizzy was in her rights to want to limit exposure if she could. I do think she does not know why certain people refused so we cannot make judgements. However, one of the saving graces of my residency was that we took care of each other and helped each other through.

Sierra93: Walk a while in my shoes. You have no idea what my family went through. You also have no idea what I went through personally to even finish high school and get to college, never mind what came next. My co-workers don't know, and you can bet my classmates didn't, either. Why? Because my classmates and co-workers have no clue how privileged and fortunate they really are. I'd venture to say: neither are you. Grow up. People sometimes aren't what they seem to be.

sunniday: Yup, this was one of Fizzy's more evenhanded posts. She took responsibility for choices she made. She also continued to judge those who refused to cover for her. I have an excellent idea of why some may have refused, hence my comments.

It is very sad that in medicine there is no back up for personal emergincies, sickness, etc. I hope one day to see that eevry training program, institution, hospital, routinely has float MD's, PA's to allow people to do what they can at work without jepordizing their health/fetuses/employment. In my med school women who had kids, would drop out for a year, same in training and at work. Temporary help would be hired. It is sad in this country that in need we have to ask for help facing rejection, it hurts. Work environment should be protected from such hurts. Pregnancy should automatically involve coverage on institutional/employer level. How come we do not see it will save us from burn out, loosing staff and will be more productive. Fizzy, I too covered for anyone without a second thought, and when on maternity was faced with coverage rejection. Does not always go both ways. I love your bitterness, and sharing it here. But am also glad I am no holding anything against anybody. It (hurt) is over.

Sierra93: I appreciate your support, really. I kind of stopped taking that anonymous poster seriously when she said she didn't want to hang out with me because we wouldn't have anything in common. What a strange argument. Like, I guess she thinks we'd like different movies or something? :) Seriously though, I think she's been through something awful and she's having difficulty dealing with it.

Kelly: There was a pregnant ID fellow when I was an intern and I think it limited her a lot that she couldn't go see certain patients. But she never took the risk. If we're going to give up eating sandwich meat and drinking caffeine, the least we can do is avoid exposing ourselves to radiation and influenza.

Sunniday: I think there were many people in my residency who were awesome about covering. I post about negative things because I think it's more interesting, but there are also so many people who I am grateful to for the help they gave me. When I was really sick and about to drag myself to work, the resident who I had worked with the day before actually called me at home and offered to cover my clinic without my even having to ask. I mean, that was awesome. I'd like to think I tried to help and cover for people too. I once even covered for a resident so she could pick up her boyfriend at the airport.

Anon that I've been arguing with: I'm sorry you went through an experience that was so horribly emotionally scarring. A lot of people have been through similar things (one of my classmates admitted that she herself had lymphoma prior to starting med school). It obviously affected you a lot and hopefully you've been in counseling to deal with the trauma.

Anon@4:34: I agree strongly. In residency, our vacations weren't built into the schedule so we had to ask permission from fellow residents for coverage in order to have any vacation. We ended up feeling guilty just taking vacation.

>>What a strange argument. Like, I guess she thinks we'd like different movies or something?>>

Actually, you are the one who said we wouldn't hang out. I said the type of person you were during your residency - per your description of yourself - is the type of person I avoid at work. Which I do. Don't know what you're like now, but I don't make a practice of socializing with co-workers.

The fact is, your life prior to medical school was nothing like mine. The majority of my classmates came from backgrounds like yours: both parents college-educated (many children of physicians), comfortable income, excellent high school, health insurance, etc. They took it for granted they'd finish training and go on to live comfortably. I had the expectation I'd have to work hard for everything I got, because there was no safety net.

Like I said, you have no idea where I'm coming from. Thanks for your concern, I guess.

Fizzy -- Is anonymous someone who HAS to have the last word or something? I thought of all your posts, this was one of your most even handed and self deprecating. And, while maybe we all are spoiled rich brats who've never had to really work hard or worry a day in our lives (puh-leeze), none of us should have to apologize for where we came from.

Hanging out with a person who has a big chip on their shoulder is no fun, even if they did have to work harder to get there. I have some acquaintances like this and sometimes want to tell them: Maybe you started in a more disadvantaged spot than I did, but congrats, you're exactly where I am now. That means you're probably smarter AND harder working. Now that we have that out of the way, can we please get on with interacting like normal people again?

OMDG: I don't even entirely know what I'm arguing with Anon about anymore. We were talking about radiation and pregnancy at first, but now for some reason out of nowhere she's talking about her parents being poor? Um, okay. I don't get it. What am I supposed to say to that? What in the world does it have to do with radiation during pregnancy?

Good heavens, all that spleen being vented. Thanks for sharing your POV Fizzy.

I was asked several weeks ago to (unshielded) bag a patient in CT. Luckily I wasn't asked by anyone senior (I flatly refused) or in any authority over me, and the option of hooking up to a portable vent was the best one (particularly as the CT tech was 10 minutes off being ready). I wasn't pregnant but I think that family history (i.e having a specific gene) could actually be a good argument for stepping out. The feasibility of this (and likelihood of other people covering for you) is another matter completely though.

I think the family history thing is a slippery slope though. If you exempt people with a family history from radiation, then maybe anyone with a cardiac family history should be exempt from any kind of lifting or whatever. Pregnancy is a very specific, temporary condition. I do think if you feel you have a higher risk than the general population, it's a good idea to avoid a career where there's much radiation exposure.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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